2020-06-07T09:59:06Zhttp://ijhr.iums.ac.ir/?_action=export&rf=summon&issue=32742016-06-01International Journal of Hospital Research2251-89402251-8940201652Estimation of Production Function of Direct Health Care Services Delivered by Iranian Social Security OrganizationSattarMehrabanHosseinRaghfar<strong>Background and Objectives</strong>: Social Security Organization (SSO) is the second largest organization to the Ministry of Health and Medical Education (MOHME) in providing health care services in Iran. In recent years the gap between the SSO’s resources and expenditures has shown an unprecedented growing trend due to the rapidly increasing demand. Continuation of this trend may lead to financial imbalance in the following years, which would negatively impact access of public to health care services. This study, thus, seeks to explore factors affecting the efficiency of SSO’s health care services in quest for solutions to alleviate the potentially critical situation ahead.<br /> <strong>Methods</strong>: A microeconomic analysis was carried out by Panel SFA method. Cobb-Douglas production function was estimated based on Maximum Likelihood Estimation (MLE), using seven-year panel data derived from the yearbooks of SSO (2008-2015). The annual admission rate was selected as the output variable and it was assumed to be a function the number of physicians, nurses, active beds, paraclinical and other staff, and the bed restoration interval. Calculation was carried out using Frontier Version 4.1 Software.<br /> <strong>Findings</strong>: Significant elasticity coefficient of 0.835, 0.073, 0.0273, -0.199 was obtained for active beds, physicians, nurses, and bed restoration interval respectively. The marginal production of inputs was calculated to be 79.14, 9.48, and 1.73 for active beds, physicians and nurses, respectively. The marginal rate of technical substitution (MRTS) was identified to be 0.18 for nurse-physician, 0.02 for nurse-bed, and 0.12 for physician-bed substitution. The η and were calculated to be 0.015 and 0.581, respectively.<br /> <strong>Conclusions: </strong>Our results clearly shows that the production (annual patient admission rate) in SSO’s hospital is capital intensive being highly dependent on number of active beds with increasing return to scale. The inefficiency has only marginally decreased over time, yet there is room to improve production by increasing efficiency. The MRTS for nurse-physician substitution suggests that the escalating burden of physicians’ wage may be reduced by employing nurses in the services they can deliver instead of physicians. The negative contribution of bed restoration interval to production highlights the challenging nature of quality improvement by increased ALS, which is currently low in SSO’s hospitals. The problem of inconsistency between quality services and high production, thus, persists pointing to the need for in-depth reform in the structure of health care delivery.Hospital EconomicsHealth care deliveryfinancial managementHealth Care SystemSocial securityOrganizational efficiency201606014651http://ijhr.iums.ac.ir/article_43959_c44342151c629f6de78b25ab0e11b8f1.pdf2016-06-01International Journal of Hospital Research2251-89402251-8940201652Physician Empathy towards Patients: A Survey in Iranian Teaching HospitalsAliMohammadiKoroshKamali<strong>Background and Objectives:</strong> Empathy is a key element of physician-patient relations, playing a significant role in effectiveness of health care. This study aimed to evaluate the level of empathy of specialist physicians and advise strategies to promote empathy.<br /> <br /><strong>Methods: </strong>All 142 specialist physicians practicing in teaching hospitals of Zanjan City (Northern Iran) were surveyed. The 20-item Jefferson Scale of Physician Empathy (JSPE) was used as the study tool. The answers were quantified on a 7-point Likert-type scale ranging from strongly disagree (1) to strongly agree (7). Data were summarized using descriptive statistical methods. The mean values were compared by t-test and ANOVA.<br /> <strong>Findings:</strong> The overall empathy score averaged at 100.7 ± 17.7 falling within the moderate range (max = 140). While the highest score of the empathy dimensions was received by <em>compassionate care</em> (5.22) and the lowest score was belonged to <em>standing in the patient’s shoes</em> (4.89). Female physicians exhibited significantly higher empathy level (107.3 ± 15.6) compared to their male counterparts (96.4 ± 16.6) (P = 0.003). The empathy score mean was found to be significantly higher among physicians with human<em>-</em>mediatedspecialties (113.05 ± 16.2) as compared with technology mediated, tool-mediated, and non-primary care specialties which scored 98 ± 12.12, 98.2 ± 18.7, and 97.1 ± 15.9, respectively (F = 5.14, P = 0.002).<br /> <br /><strong>Conclusions: </strong>The observed level of empathy among physicians indicates a large room for improvement, particularly among male doctors and technology/tool mediated specialties. Considering the crucial role of clinical empathy in patient satisfaction and outcome, our results recommend further studies to examine the issue on larger scales and devise intervention strategies if the observed gap will be confirmed.Physician-patient relationsEmpathyPatient SatisfactionPatient OutcomeHealth care effectiveness201606015257http://ijhr.iums.ac.ir/article_17286_fed5c2bcbc7323d96a16d743d92a2eea.pdf2016-06-30International Journal of Hospital Research2251-89402251-8940201652Nursing Time Allocation: A Wok Sampling Survey in a Turkish Private HospitalDilekEkiciEmelGurkay<strong>Background and Objectives</strong>: Work sampling is a useful technique to characterize how employees allocate their work time to various activities. Given the value of nurses’ time for quality health care delivery, characterization of nursing time distribution may provide useful information for optimal use of nursing staff. The purpose of the present study was to explore time allocation by nurses using work sampling method.
<strong>Method:</strong> The study was conducted in a 150-bed private hospital. Data was collected using a researcher-designed work-sampling tool addressing 259 tasks grouped into four high-level activities, including direct care, indirect care, and unit-related, and personal activities. By conducting a pilot study, a sample size of 669 was determined for observation. In practice, however, a total of 228 nurses were observed in 540 shifts, which provided a robust sample for data analysis. Data were collected at 20–30 minute intervals over a nine-week period. The nurses’ activities were randomly observed and recorded by 12 trained observers.
<strong>Findings:</strong> A total of 17517 nursing activities were observed for the day shifts and 12902 for the night shifts. The nurses were found to spend 44–46% of their work time on direct care, 20–22% on indirect care, 10–14% on unit-related duties, and 20–24 % on the personal activities, depending on shift time. The proportion of nursing time specified to direct patient care was the highest in the Emergency Department (55%, day shift, 57%, nigh shift) and the lowest in Maternity Ward (35%, day shift, 32%, night shift). Administration of medication (28.7%, day shift, 28.4%, day shift) and monitoring patients’ vital signs (25.6%, day shift, 26.7, night shift) were identified as the most time-intensive patient care tasks. The nursing time distribution was virtually the same in the day and night shifts. The proportion of time spent on personal issued (22%, day shift, 25%, night shift) was found to be higher than that required by the hospital.
<strong>Conclusions:</strong> While the nursing staff spends the majority of work time on direct patient care, the time spent on personal activities is relatively high, requiring specific inspection. Our results identify the most time-intensive nursing tasks and provide potentially useful data for optimal design of nursing schedule.work samplingNursing staffPatient careHealthcare human resourcesHospital management201606305863http://ijhr.iums.ac.ir/article_17284_80b112024c3966e312fece7e21d2dcdd.pdf2016-06-30International Journal of Hospital Research2251-89402251-8940201652Survey of Hospital Solid Wastes Management in North of IranZahraNamvarHosseinaliAsgharniaHouriehFallahAbdolimanAmouei<strong>Background and Objectives<em>:</em></strong> Disposal of hospital wates is a significant environemtal concerns, particularly in develoing regions of the world. Addressing this challenge relies on availability of detailed data on the current status of wate management. Mazandaran Province is located in southern coast of the Caspian Sea and thus its environmental status may directly influence the environment of this Sea. The present study aimed to characterize the situation of hospital solid wate management in this province.<br /> <br /><strong>Methods:</strong> The solid waste management of 40 hospitals of various types were surveyed. Data were collected by a researcher-made questionnaire and summarized using descriptive statistical methods.<br /> <strong>Findings: </strong>Mean per capita of infectious, general, sharp, and total wastes, was fround to be 0.95, 1.59, 0.06, and 2.61 kg/bed/day, respectively. A total of 36.1% of all waste is hazardous waste (infectious and sharp wastes). The distance between the temporary place of waste and the nearest hospital ward is < 20 m in 15%, 20-50 m in 52.5%, 50-100 m in 12.5%, and > 100 m in 20% of the hospitals. This time of wast residence is < one day in 42.5%, one day in 37.5%, two days in 12.5%, and one week in 7.5% of hospitals. The type of temporary place of waste was a roofed concrete chamber, a metal container, an outdoor area, and a tightly-closed plastic container, respectively, in 82.5%, 10%, 5%, and < 1% of the hospitals. The infectious waste is incinerated in 57.5%, autoclaved/hydro-claved in 35%, and disposed untreated in < 1% of hospitals. Infection control training courses are held every month in 27.5%, every three months in 12.5%, every six months in 40%, and once a year in 17.5% of the hospitals.<br /> <br /><strong>Conclusions:</strong> A large volume of the total hospital waste is hazardous waste. Desposal of waste in more than half of the hospitals take one day or more. The environmental and health risk associated with this situation calls for appropriate measures. More than half of the surveyed hospitals treat their wast by incineration which may release considerable amounts of air pluants. Equipping these hospitals with autoclave and hydro-clave devices is thus significant to protection of the environment.Waste ManagementMedical waste disposalSolid wastehazardous waste201606306468http://ijhr.iums.ac.ir/article_17543_1557a3d430eb43c6804e1ee9e41fc09e.pdf2016-06-30International Journal of Hospital Research2251-89402251-8940201652Prevalence and Microbiological Profile of Catheter Associated Urinary Tract Infections: A Case Study in Secondary Care HospitalAymenElsousMahmoudOudaSamahMohsenMohammedAl-ShaikhSihamMokayad<strong>Background and Objectives: </strong>Healthcare-associated infections is a major health care concern posing potentially serious negative impact on patient safety and outcome. In this paper, we report this microbiological profile and the prevalence of Catheter Associated Urinary Tract Infections (CAUTIs).<br /> <br /><strong>Methods: </strong>This was a prospective observational study for 60 inpatients from eight wards among patients having indwelling catheter for at least 48 hours. Urine cultures were taken in initial phase within 24 hour of admission, at 48 hours and in day 5 of catheterization.
<strong>Findings: </strong>The rate of CAUTIswas 16.7% after 48 hours and 28% (7/25) after 5 days from insertion the indwelling catheter.<em>Candida</em> spp. was the most common cause of CAUTIs (29.4%), followed by <em>E. coli</em> (23.5%), <em>Streptococcus</em> spp. and <em>Klebsiella</em> spp. (17.6%) and last <em>Staphylococcus</em> spp. (11.7%). The coronary care unit (CCU) showed the highest prevalence of CAUTIs (57.1%), followed by Oncology (42.8%), and Internal Medicine (33.3%). Females showed a significantly higher rate of acquired urinary tract infections compared with males (P < 0.05).<br /> <br /><strong>Conclusions: </strong>The risk of CAUTIs was found to be relatively high and increase by duration of catheterization. These results recommend minimally usage of catheter in medical practice in terms of both frequency and time, particularly for female patients and in CCU ward. Identification of the microbiological profile of the CAUTIs would help efficient treatment of the infected patients.<br /> Catheter associated urinary tract infectionsPrevalenceHospitalmicrobiological profile201606306973http://ijhr.iums.ac.ir/article_17287_0a1f7b9b481d65b464ecdbb2ea28ecd1.pdf2016-06-30International Journal of Hospital Research2251-89402251-8940201652Designing a Branding Model for Public Teaching Hospitals in IranElhamAfzalMohammad HosseinModarresiMohammad RezaMalekiAmir AshkanNasiripour<strong>Background and Objectives: </strong>HospitalBranding is a new concept in Iran that requires focused attention in order to enhance economic performance of health care delivery system. This study aimed to develop a conceptual framework for initiation and promotion of public teaching hospital brand in an Iranian context.<br /> <strong>Methods:</strong> A comparative study of hospital branding in eight pioneer countries revealed 51 elements potentially influencing successful hospital branding. Based on expert opinion, these elements were refined and adapted to the Iranian context. Based on this information a 47-item questionnaire was designed. The questionnaire was distributed among 364 experts from different health domains, including clinicians of public and private hospitals and policy makers, executives, and authorized advisors from MOHME and various medical universities. The collected data were analyzed using exploratory factors analysis in order to identify factors influencing hospital branding. The robustness of the identified factors was further explored by confirmatory factor analysis.<br /> <strong>Findings</strong>: Identity, image, competitiveness, strategy, and relationship were identified as the five key dimensions of hospital branding in the Iranian context.<br /> <strong>Conclusions:</strong> Identification of the major dimensions of hospital branding may help policy-makers to develop effective brand promotion strategies in hospital industry.HospitalBrandingHealthcareMarketing201606307481http://ijhr.iums.ac.ir/article_43966_6e30188d7e0ce5b7b8e59d56453039fa.pdf